Parent/Guardian Acknowledgment Form

Garfield Elementary School- HVPS /
Learning Center Coordinator
Name: Kelsey Moore
Phone Number: 575-646-3695
Email:
Local Program Director
Name: Susan Brown
Phone Number: 575-646-1397
Email:
School Campus Principal
Principal Name: (acting) Linda Hail
Phone Number: 575-267-8200
Email:

Contents

PARENT/GUARDIAN ACKNOWLEDGMENT FORM

STUDENT REGISTRATION

MEDICAL AUTHORIZATION FORM

PARENTAL PERMISSION FORM

SECTION I: 21st CCLC INTRODUCTION

OVERVIEW

GOALS AND PERFORMANCE MEASURES

SECTION II: ENROLLMENT AND ATTENDANCE

ATTENDANCE POLICY

SECTION III: PROGRAM HOURS AND ACTIVITIES

HOURS OF OPERATION

HOLIDAY & STORM DAY POLICIES

DISMISSAL

EARLY PICK-UP

LATE PICK-UP

FAMILY PARTICIPATION

SECTION IV: BEHAVIOR POLICY

SECTION V: 21st CCLC STAFF AND VOLUNTEERS

SECTION VI: COMMUNICATION

SECTION VII: ADDITIONAL DETAILS

SNACK/MEAL

MEDICATIONS

HEALTH & SAFETY

21st CCLC EMERGENCY POLICY

NATURAL DISASTERS & OTHER EMERGENCIES

FIELD TRIP PERMISSION

PERSONAL BELONGINGS

PARENT/GUARDIAN ACKNOWLEDGMENT FORM

21st Century Community Learning Centers (CCLC) is an out of school time program offered free of charge through a federal grant administered by the New Mexico Public Education Department. The program offers academic, leadership, and enrichment opportunities for students and families. Program is offered Monday through Thursday, directly after the regular school day. All 21st CCLC students must participate on a regular basis. If program is offered both morning and afternoon, students are not required to attend both sessions.

Family group activities will be offered on some evenings throughout the fall and spring semesters. Please attend as many activities as possible! Family participation is very important to our grant because 21st CCCL has a dual capacity framework, meaning we serve both students AND families!

Your daughter/son is expected to meet expectations and participate. Instructors use positive reinforcement during the out of school time program to keep a positive and fun learning environment! To maintain a good learning environment, we will not allow harassment or bullying. We have a “zero tolerance” policy for any weapons or controlled substances. We follow the school district’s Code of Conduct Handbook practices and procedures. Expectations during the out of school time program are the same as during the traditional learning day. We have a behavior/discipline policy that states if a student has a discipline issue, the teacher and instructional assistants will determine the cause of the behavior issue and act accordingly. If your child is disruptive and disrespectful to the instructor, guests, peers, and materials and supplies, parents will be notified. If this occurs regularly (more than three times) the student may be asked not to return. If the behavioral issue is resulting in an issue stemming from home, we will make special accommodations to meet that individual’s needs during the out of school time opportunities. We reserve the right to suspend or terminate a student from the out of school time program immediately, if a student’s behavior warrants it. Please refer to the remainder of this Family Handbook for more information.

The afternoon program hours will be determined. We will not be open on non-school days. There won’t be morning program on delayed schedule days or afternoon/evening services on early release days. Please read and discuss this family handbook with your child. Then, please sign this form and return it to the out of school time learning center coordinator along with the completed registration forms. The program is based on first come, first serve so return your student application to the front office to be date stamped and recorded. Bus services will be available in September and you will be notified if your child is eligible for transportation.

______

Student Name

______

School

______/______/______

Parent/Guardian Name (Print) Date

______/______/______Parent/Guardian Signature Date

Please return this signed form to your 21st CCLC School Coordinator with your 21st CCLC registration forms.

STUDENT REGISTRATION

Garfield Elementary School - HVPS

NMSU STEM Outreach 21st CENTURY COMMUNITY LEARNING CENTER PROGRAM

Student information:

Name (First) ______(Middle) ______(Last) ______

Grade:______Name of School:

Date of Birth ______Race (optional) ______Age ______

Gender (select one)  Female  Male  Transgender

Mailing Address:Street ______

City______State______Zip Code ______

Parent/Guardian Information:

Parent/Guardian 1 Information / Parent/Guardian 2 Information
Name
Cell Phone
Home Phone
Work Phone
Email Address

How will your child get home from the program? (select one)

 Walk Parent/Guardian Pick-Up  Bus Other: ______

Person(s) authorized to pick up child besides parent/guardian(s)

Name / Contact Phone Number

1. ______

/ ______

1. ______

/ ______

1. ______

/ ______

______

Signature of Parent or Guardian Date

MEDICAL AUTHORIZATION FORM

Student’s name (please print):

First ______Middle ______Last______

Person to be contacted in case of emergency:

Name______Relationship ______

Phone ______

Alternate person to be contacted in emergency:

Name______Relationship ______

Phone ______

Please list below any health-related condition the director of the program should know about your child. (Reporting such conditions will not prevent your child from participating and will be kept confidential.)

Allergies/food (explain) ______

Allergic to any drug(s) (explain) ______

Diabetes ______

Heart Condition ______

Epilepsy ______

Convulsions ______

Emotional Upsets ______

Asthma ______

Other Conditions? ______

List below any medication being taken now (including aspirin):

Circle any medications that your child will be bringing to the program.

1. ______
2. ______
3. ______
4. ______
5. ______

Are there any activities in which the child should not participate?

______

Are there any physical restrictions?

______

I, being a person authorized by law to give such permission, do hereby give my permission for emergency medical treatment to be given to the student listed on this form. I understand that all reasonable attempts will be made to contact me as soon as possible after the condition necessitating treatment arises, and, if unable to reach me, all reasonable attempts to contact the alternate listed above will be made. I understand that all reasonable precautions will be taken for safety at all times. I further release 21st Century Community Learning Centers and all persons associated with this organization from any liability associated with any accident, injury or disease to the person who is the subject of this form.

______

Signature of Parent/Guardian Date

PARENTAL PERMISSION FORM

Student’s name (please print):

First ______Middle ______Last______

The 21st Century Community Learning Centers (CCLC) program must provide documentation to the New Mexico Public Education Department and U.S. Department of Education concerning progress of the program. We may need to access attendance records, test scores, report cards, and/or transcripts. Additionally, we will distribute surveys to collect information in order to help improve program quality. All information will be strictly confidential. Please select one of the following choices for accessing this information for program quality enhancement purposes.

 I give my permission for the 21st CCLC program to access my child’s grade/assessment and attendance data through my child’s school.

 I DO NOT give the 21st CCL program my permission to access my child’s grade/assessment and attendance data through my child’s school.

Sometimes there may be activities during which your child uses the internet for tutoring and/or other academic activities. Students will always be monitored and supervised when they are on the internet. Please select one of the following choices:

 I give my permission for my child to access the internet.

 I DO NOT give my permission for my child to access the internet.

During the program, photographs or video recordings may be made of students performing various activities. These might be used in the newspaper, a flyer/brochure, and/or our web sites for promotion of the program. Please select one of the following choices:

 I give permission to use my child’s photos/videos in the manners described above.

 I DO NOT give permission to use my child’s photos/videos in the manners described above.

Parent or Guardian’s Name (Please print):

______

Parent or Guardian’s Signature: ______Date: ______

SECTION I: 21st CCLC INTRODUCTION

OVERVIEW

21st Century Community Learning Centers (CCLC) out of school program help students with their schoolwork by offering them the chance to explore topics they study during the traditional learning day in interesting and fun ways.

Program activities support student academic growth in meeting the Common Core State Standards in language arts, mathematics, and science. Activities are innovative and hands-on. They are built on learning goals that are shared with youth. The program also strives to create strong, transparent connections to both college and career exploration and readiness. Additionally, it includes sessions that promote health and wellness that supports a student’s success in school.

GOALS AND PERFORMANCE MEASURES

1.Maintain and improve student academic achievement in language arts and math.

a.Seventy-five percent (75%) of students earning a passing grade after the first grading period will maintain a passing grade by the close the academic year.

b.Fifty percent (50%) of students earning below a passing grade after the first grading period will raise their grade by the close of the academic year.

c.Assessment results from short cycle assessment selected by the district should be recorded with the goal of a one point/grade level increase for 80% of students by the close of the academic year.

2.Design and deliver a 21st CCLC program which meets the needs of all constituent groups.

a.85% of all survey participants will agree or strongly agree that the 21st CCLC program being offered in their community is high quality.

3.Implement a program that engages students.

a.75% of the target enrollment goal will be met each academic year.

b.An average attendance rate of 75% will be maintained throughout the academic year.

SECTION II: ENROLLMENT AND ATTENDANCE

ATTENDANCE POLICY

This learning program is provided FREE OF CHARGE to students (and their families) attending Garfield Elementary School and enrollment is on a first come, first served basis. This is possible because the program is funded through a federal grant, administered by the New Mexico Public Education Department and provided to you through New Mexico State University’s STEM Outreach 21st Century Community Learning Centers. After returning the Parent/Guardian Assurance and 21st CCLC Enrollment Forms, families will be notified if their child has been accepted for participation in the 21st CCLC program.

Attendance is a very important part of our program. In order for your child to get the most out of the program, he/she must attend daily. Attendance also impacts how the program is funded. It is important that each student attend each day for the full program length. When students are absent, funding is reduced, increasing the possibility of the loss of the program. Parents are responsible for contacting their academic enrichment teacher, if their child will be absent. If a child has a prior commitment, written notice containing the parent/guardian’s signature, and stating the reason for the weekly/monthly absence must be provided to the Learning Center Coordinator. This notice will become part of the student’s 21st CCLC file. Because we may have a waiting list for available seats, frequent absences may result in your child’s removal from the program.

21st CCLC EXCUSED ABSENCES:

 Illness of student

 Serious illness or death of family member

 Head lice or nits

 Doctor or dental appointments

 Legal matters

 Religious holiday or training

 Unforeseen emergencies (e.g. natural disasters)

 Prior commitment that has been documented in student file by the parent/guardian

The Learning Center Coordinator or academic enrichment program teacher will contact the parent/guardian of any student having over three unexcused absences. Continued excessive absences may result in the student being removed from the program to allow space for another student on the waiting list.

UNEXPECTED ABSENCES

If your son/daughter is absent during program, and the Learning Center Coordinator has not been contacted regarding this absence, you will be phoned. If the primary contact cannot be reached, every person listed on the registration contact list will be phoned until someone is reached. Please contact Kelsey Moore or the academic enrichment program teacher at in advance if you know your child will be absent from the 21st CCLC program. Your child’s safety is our top priority. We would never want to assume a child is with their family, while the family assumes the child is attending program. That is why communication with the program coordinator is so important. It’s about your child’s safety!

SECTION III: PROGRAM HOURS AND ACTIVITIES

HOURS OF OPERATION

The 21st CCLC program begins on September 5th, 2017 and ends on December 15th, 2017. The program will resume January 16th through May 19th, 2018. We will notify parents in March if Garfield ES will be a site for summer programs.

After School

The out of school time program operates from 2:30pm – 4:30pm Monday -Thursday. The last day of program during the academic year will be on Thursday, May 18th 2017.

During the afternoon hours, students will participate in academic and enrichment activities. Activities will include homework help, SEMAA – Science Engineering, Mathematics, and Aerospace Academy, Readers Theater, DiMA – Digital Media Academy, COUNT – Creating Opportunities Using Numerical Thinking, and school selected electives including but not limited to gardening, robotics, and First in Math.

Summer Program

If Garfield ES selected as a central school to house the summer program, it will begin on, June 4th and end on June 22, 2018. The summer program operates from 8:30am – 2:30pm Monday – Friday.

Students will participate in academic and enrichment activities. Activities will be based on the themes explored through SEMAA, Readers Theater, DiMA, COUNT, and electives.

HOLIDAY & STORM DAY POLICIES

During the regular academic year, the calendar for the 21st CCLC program follows the calendar of the school district. On days when there is no school, including snow days, the 21st CCLC programs (morning and afternoon) are not in session. If a late start for school is announced due to weather conditions or any reason, there will be no program before school. If school is released due to bad weather, program will not be provided after school hours. On school days when regular classes are in session, but bad weather is predicted for late afternoon, the afternoon program hours may be canceled, and parents will be notified.

DISMISSAL

As described in Section II of this handbook, attendance is important to our program. In order for your child to receive the full benefit of this opportunity he/she must attend each day for the full program length. The procedures outlined below will be followed during program dismissal:

• Students taking the bus home will be taken to the designated bus loading zone by the academic enrichment instructor. The instructor will wait for the bus to be loaded before reentering the school.
• Students who have permission to walk home will be walked to the main entrance of the school. If the school is located on a busy street or one that has traffic, designated staff will walk the students across the street to ensure safe crossing.
• Students being picked-up will be taken to the main entrance of the school where designated adults will pick them up. If students are to be picked-up by persons other than those designated at the time of registration (those listed on the student’s registration form), the Learning Center Coordinator must be notified prior to pick-up time, or the student will not be released to the individual who has arrived for pick-up.

EARLY PICK-UP

We discourage picking up your child early. Qualified instructors plan curriculum based on the full program time available. Your son/daughter will not receive the full benefit of program if they are not participating in the full program day. We understand that early pick-up may be required sometimes. Please try to limit those times as much as possible.

If you will need to pick-up your child during regular program hours, please contact the Learning Center Coordinator in advance to communicate the time you will be arriving to pick-up your child. If we have this information prior to or at the start of program, we can make sure your son/daughter is in the front office and ready to leave the building.

When you arrive, please check-in at the front office, and be sure to sign your child out for the evening before leaving the building.

A student may be dismissed from program if they are picked-up early more than five times in one semester. Please note, this does not include prior commitments that have been documented in the student’s 21st CCLC file by the parent/guardian.

If you want a person other than those listed on the registration form to pick up your student, the Learning Center Coordinator must be notified prior to pick-up time.

LATE PICK-UP

Students must be picked up within 15 minutes after program ends. This means by 4:45 pm Monday and Wednesday. The learning center is not staffed after these hours. A student may be dismissed from program if he/she is picked up late three times. Local authorities may be contacted for assistance if a student is not picked-up after program hours, and we can’t contact the parent/guardian or emergency contacts.

FAMILY PARTICIPATION

Family involvement is a very important component of your child’s education; we encourage each adult family member to participate in this program as much as her/his schedule allows. Each month, we offer an activity in the evenings for both the parent and their child, or just for parents. Activities may include, but are not limited to the following types of workshops: healthy cooking and lifestyle choice, digital and social media navigation, English as a Second Language, homework assistance, and community/family events.

The community/family events are designed to be fun for the whole family! We hope you’re able to attend! We will provide the schedule for these events at least one month in advance, when the monthly family newsletter is sent home.